Family Dental of Roscoe Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019.028238 Issued in IL

Legal business name

FAMILY DENTAL OF ROSCOE INC

Practice address

3332 N Western Ave
Chicago, IL 60618-6213

Phone

(773) 679-2419

NPI assigned

Jun 9, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Olena Obeid

Title

Ceo

Phone

(773) 679-2419

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1205285293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3332 N WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 N WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186213",
            "telephone_number": "773-679-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL OF ROSCOE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "OBEID",
        "authorized_official_first_name": "OLENA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-679-2419",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.028238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.